| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
902 |
797 |
$37K |
| D1206 |
Topical application of fluoride varnish |
877 |
779 |
$30K |
| D0120 |
Periodic oral evaluation - established patient |
835 |
738 |
$17K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
78 |
54 |
$8K |
| D0272 |
Bitewings - two radiographic images |
327 |
288 |
$8K |
| D1351 |
Sealant - per tooth |
187 |
43 |
$6K |
| D1310 |
|
144 |
128 |
$5K |
| D1330 |
|
145 |
129 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
136 |
123 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
52 |
36 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
43 |
30 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
91 |
79 |
$3K |
| D0240 |
|
74 |
59 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
55 |
45 |
$2K |
| D0274 |
Bitewings - four radiographic images |
32 |
28 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
60 |
51 |
$880.00 |